Postobstructive pulmonary edema induced by endotracheal tube occlusion

Pulmonary edema is a well-described complication of upper airway obstruction, most commonly caused in adults by postanesthetic laryngospasm. The mechanism initiating the formation of postobstructive pulmonary edema is believed to be the markedly negative intrapleural pressure generated by a forceful inspiratory effort against an obstructed extrathoracic airway. We herein describe a young, male patient who developed pulmonary edema postoperatively, upon emergence from anesthesia, after performing repeated, forceful inspiratory maneuvers directed against an endotracheal tube on which he had bitten down, thereby occluding it. To our knowledge, such an etiology of postobstructive pulmonary edema has not previously been described.